Provider Demographics
NPI:1851769798
Name:MCMILLEN DICKEYTESDALL, LYNAE DIANE (MS LMHC)
Entity type:Individual
Prefix:
First Name:LYNAE
Middle Name:DIANE
Last Name:MCMILLEN DICKEYTESDALL
Suffix:
Gender:F
Credentials:MS LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 S MONROE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-5678
Mailing Address - Country:US
Mailing Address - Phone:641-423-1178
Mailing Address - Fax:
Practice Address - Street 1:1415 S MONROE AVE STE C
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-5678
Practice Address - Country:US
Practice Address - Phone:641-423-1178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA074799101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0159608Medicaid